Haas Franz, Hubmer Martin, Rappl Thomas, Koch Horst, Parvizi Irene, Parvizi Daryousch
Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria.
J Trauma. 2011 Aug;71(2):460-6. doi: 10.1097/TA.0b013e3181e997fc.
Several authors have reported overall survival rates after thumb replantation; however, to date, only few studies have been concerned with functional outcome after thumb replantation, with assessment of range of motion, grip strength, and additional functional tests (Quick DASH and modified Mayo score). We chose to design and execute a study to evaluate the functional and subjective results after thumb replantation.
A total of 34 patients (3 women and 31 men) with replanted thumbs returned for additional testing that consisted of an interview using the Quick DASH questionnaire and physical examinations including objective measurements of hand strength, range of motion, and sensibility. These objective measurements as well as satisfaction and pain were evaluated with the specially designed trauma score called modified Mayo score. Furthermore, correlation analyses between Quick DASH, modified Mayo score, and objective parameters were performed.
The Quick DASH score was 11.3 (SD, ±10.79). The modified Mayo score was 110 points (SD, ±15.11). Finally, the Quick DASH score showed a significant correlation with our modified Mayo score (Kendall tau rank correlation coefficient, τ = -0.25; p = 0.04).
Functional results were independent of amputation level, length of ischemia, and patients age. Although sensory recovery and functional outcomes of the extrinsic muscle system were moderate, patients were able to use their thumb to perform work and daily living activities. The significant correlations of objective clinical tests and a mixed trauma score (modified Mayo score) with the Quick DASH allows the clinician to compare the postoperative result with the patient' functional competence in daily activities.
几位作者报告了拇指再植后的总体生存率；然而，迄今为止，仅有少数研究关注拇指再植后的功能结果，包括对活动范围、握力及其他功能测试（Quick DASH和改良Mayo评分）的评估。我们选择设计并开展一项研究，以评估拇指再植后的功能和主观结果。
共有34例拇指再植患者（3名女性和31名男性）返回接受进一步测试，包括使用Quick DASH问卷进行访谈以及体格检查，其中体格检查包括对手部力量、活动范围和感觉的客观测量。这些客观测量结果以及满意度和疼痛情况，均采用专门设计的创伤评分即改良Mayo评分进行评估。此外，还对Quick DASH、改良Mayo评分与客观参数之间进行了相关性分析。
Quick DASH评分为11.3（标准差，±10.79）。改良Mayo评分为110分（标准差，±15.11）。最后，Quick DASH评分与我们的改良Mayo评分显示出显著相关性（肯德尔tau等级相关系数，τ = -0.25；p = 0.04）。
功能结果与截肢水平、缺血时间及患者年龄无关。尽管外在肌肉系统的感觉恢复和功能结果一般，但患者能够使用拇指进行工作和日常生活活动。客观临床测试及混合创伤评分（改良Mayo评分）与Quick DASH之间的显著相关性，使临床医生能够将术后结果与患者日常活动中的功能能力进行比较。
